Comparative analysis of surgical techniques for pediatric diaphyseal forearm fractures: A focus on titanium flexible nails versus plates and screws

Diaphyseal forearm fractures are frequently encountered in patients with immature skeletons. Proper management of these fractures is crucial for achieving the best possible outcomes. In this study, we compare two prevalent fixation methods for pediatric diaphyseal forearm fractures: plate and screw fixation versus titanium elastic nails (TEN). This study was a prospective, randomized controlled trial conducted at Shahid Bahonar Hospital in Kerman, Iran. Fifty patients, aged 10–16 years, with diaphyseal fractures of the radius and ulna, were randomly assigned to one of two groups: TEN or AO–Dynamic Compression Plate (DCP). Surgical duration, length of hospitalization, and complications were assessed post-surgery. Three months post-surgery, functional outcomes and fracture union time were evaluated. Our study involved 50 patients with an average age of 12.1 years. The TEN group had significantly shorter surgery duration (mean 73 minutes vs. 98 minutes, p = 0.035) and hospital stay (mean 1.2 days vs. 2.1 days, p = 0.027) compared to the DCP group. No significant differences were observed in fracture union time (p = 0.73) or functional outcomes at three months (p = 0.143). Complications were minimal, with skin irritation being more common in the TEN group, while superficial wound infections were noted in the DCP group. TEN fixation is an effective approach for pediatric diaphyseal forearm fractures, providing the advantage of shorter surgical and hospitalization times compared to plate and screw fixation methods. Additionally, the smaller incision leads to improved cosmetic results and minimizes soft tissue injury.